Post Earthquake Anxiety in Nepal

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Nepal is currently suffering a humanitarian crisis with the earthquake that took place on the 25th of April 2015, of 7.8 richter scale. Many houses were destroyed, properties damaged and lives lost. People still are not being able to feel safe and with the ongoing aftershocks, occuring almost daily, are reminder of the initial scary feeling and dread. Most people, despite their houses are safe and many government reassurances, cannot still enter their houses and are forced to sleep outside in tents. The situation is made worst by unwanted and baseless rumors that a stronger earthquake will take place made many forced to sleep outside in tents under the open sky. Despite many professional reassurances that earthquakes cannot be predicted people are scared. In such situations, the heart wins over the mind, emotions overtake logic, and fear becomes even dreadful.

This earthquake really was massive and ravaged a huge loss both in terms of physical loss such as homes and buildings but more so in terms of loss of human lives. Many people witnessed collapsing buildings, and their loved ones or people around them losing lives.

Death is the ultimate fear we have and anything that can bring about this ultimate fear is as fearful as death itself.

Constantly aware of the growing number of death toll and loss of human lives and the unrelenting aftershocks were adding on to the fear. Every time we logged into the Facebook we could see the gruesome pictures of collapsed buildings and piles of dead people and people being rescued.

Our own existence was questioned and everyone felt so vulnerable that even the slightest movement or a frown on another person’s face made us stand up and even run.

Everything, all movements and vibrations were so set that they evoked a frightening response and people even started doubting and feeling that the earth was shaking when it really was not. We began to go off with such normal vibrations as someone moving his/her body while we leaned on that same bed or sofa.

At such times of heightened arousal and apprehension, people, very naturally though, start relating to even the movement of their own bodies as movement arising from outside and as earthquake. Many had this very “sensation” that for them the shaking never stopped and for many getting into their own homes and rooms was no more plausible.

Children were seen to suffer most from this unrelenting fear. Moreover, children of those parents who were themselves reacting in an exaggerated manner to the fear of earthquake were more likely to react. That is why we saw some children being able to sleep calmly with their parents inside their homes and some always asking to go out.

The message and information that are relayed to children is very important and we witnessed a huge number of prophecies and exact hour predictions about when the next earthquake was going to strike. These messages were not filtered from children which heightened their sense of fear. Anything that can hurt us and at the same time cannot be predicted and is beyond our resources to handle provokes more anxiety.

Working in a hospital it was not unusual to come across many cases who had this very sensation that earthquake was a continuous phenomenon and they complained “I feel that earth is still moving”. People could not enter their houses, could not study, were scared to even fall asleep. A normal life was no longer normal and was filled with a constant dread and the sense of security and safety was lost. The fear was eating us up and with this lost sense of security added onto the anxiety.

These children were experiencing the same lost trust and safety and were really scared and many were forced to always cling to their elders. Fear brings with it a sense of helplessness and the need for constant reassurance.

May parents wanted to know about how to bring back this lost sense of safety and security to their children and how to make them feel at ease. It was not only a difficult time for the children to cope with this surmounting fear but equally for the parents.

The same was true for elderly as well. Actually no one is immune and it is very normal.

Actually it was such a difficult time for everyone, and a fear havocking on our psyche, almost all of us had started having symptoms which are very natural at these times. It is said that such events produce a what is called “A very natural and normal reaction to an abnormal situation”. The problem begins when these symptoms are taken as something alien and abnormal and provoke a sense a belief that something is wrong with us which adds on to the stress.

We had a flux of individuals with these very symptoms at Kathmandu Medical College, Sinamangal, Kathmandu (KMCTH) and my clinic Center for Psychological Health & Emotional Wellbeing (CPH-Nepal).

1. Many complained of feeling nervous, restlessness, not being able to sleep properly, dizziness and irritability.

2. Most of the complaints were, that they felt that the earth was always shaking and could not walk straight and felt wobbly.

3. Many complained that they could not ride their bike and were always tormented by the fear that any jerk or instability was actually an earthquake.

4. Inability getting into their houses, despite a thorough examination by the authorities was another major issue.

5. Fear of falling asleep.

6. Fear of reoccurance of the same incidence.

To the serious side:

1. Parental Anxiety: People were not able to send their children to schools. I had few visits to schools where the children wanted to come to school because it was “fun” but parents did not allow them.

2. Panic Disorder: People were seen to have developed a condition called Panic Disorder where the all symptoms are related to cardiac symptoms such as, racing heartbeat, chest pain or discomfort, tremor, sweating, Feeling of numbness and something terrible happening and fear of death.

3. Depression:

4. Post Traumatic Stress Disorder:

Current earthquake in Nepal has also affected many individuals who are coming to Center for Psychological Health & Emotional Well-being Pvt. Ltd. for consultations. In such situations the most difficult part is that individuals are more scared of the symptoms they are having. Slowly as the life is getting back to normalcy, these symptoms are creating another wave of distress to the individuals and their families.

At such times of distress there is a sense of disbelife and anger. The anger may sometimes vent out inwards in such behaviors as suicidal ideations, "why me?" feelings, and as some of the survivors who lost their loved ones mentioned "why did I survive". These emotions sometimes are very strong and put people into a confusion as what to do next.

It is important at this time to educate people that these symptoms are just a reaction to the terrible incidence which took place and will slowly go away. It is also important to make them aware that they are not the only one who are having these symptoms and there are many individuals who are finding it difficult to manage their emotions and feelings.

What Can We Do?

1. Be with the individual and do not let him/her alone.3. Ensure the safety of the person. One can also take help of the government agencies to move the person to a safer place.
2. Let the person know that it is not only him who is feeling these symptoms but there are many more.
3. Educate the person that these symptoms are not there forever and will gradually go away.
4. Do not leave the person alone especially in the evening as these symptoms get worse as the night arrives.
5. Take them for a walk so that they can have some physical activity.
6. Make sure that they are eating well and encourage them to take pleny of fluid.
7. Let the person engage in something that is not heavy such as a humorus television serial (however avoid news and other information which reminds them of the same incidence)
8. If you still cannot manage and find it difficult take the person to a mental health professional for professional help.

Case 1:

A male child of 10 years of age was brought by his mother with the complaint that he was not able to go to school (this was very much later, after all the schools had resumed), and feared that something “terrible” will happen to his family. The child was so distressed during the interview that he could not stop crying and only asked “Is our house safe?”. He was a brave boy according to the mother before the earthquake and took pride in taking his bike outside and in buying stuffs from the shop for the parents. However, many months after the earthquake, and especially after the resumption of schools, he started having these crying spells and refused to go to school. Not only he did not want to go to school he stopped going to his friends and to shops which he always enjoyed buying stuffs from. He demanded that the family slept outside in the tent and refused to climb upstairs. Parents were somehow managing to keep him in the ground floor of their apparently unharmed and safe-to-live house. The mother also reported during the interview that his sleep was shallow and would wake up at slightest sound and sometimes would get very scared, had pounding heart, would sweat a lot and could hardly fall asleep afterwards. He also reported during the interview that he had fearful dreams.